Aims:
To obtain information on implementation of ESD in particpating centres of ten experimental ESD Training Workshops in Salzburg [Dig Endosc 2011;23:282 – 89].
Methods:
ESD WORKSHOPs lasted 3.3 days under instruction by international experts, 177 trainees from 135 referral centers had participated once or twice. A brief questionaire was mailed to participants of all 135 centres and reported data (n, %) analyzed.
Results:
Completed data from 77 of 135 centers (57%), information on zero ESD from 32 (24%), no information from 26 (19%). ESD had been implemented without supervision by expert during initial learning. Nineteen (17%) of 109 centres had performed > 150 ESD (professional level), 27 (25%) had 31 – 150 ESD (competent level), and 32 (29%) each had ≤30 ESD (initial learning) and zero ESD, resp.. Outcome (% as median, range) of centres on initial learning (n = 425 ESD) is compared to centers with > 30 ESD (n = 5439): ESD en-bloc was 75 [40 – 80]% vs. 85 [49 – 100]%, conversion to hybrid-ESD 20 [0 – 100]% vs. 11 [0 – 51]% and to piecemeal-EMR 5 [0 – 45]% vs. 4 [0 – 15]%. Majority (65 – 70%) of ESD were in colorectum (35% malignant lesions) with low risk and satisfactory oncological outcome – even during initial learning (s. table). Overall, 30 day morbidity was 0.6 ± 2.2% (stenoses), and mortality 0.04% (2 cases).
Tab. 1:
Outcome of implementation of ESD (median, [range])
|
Percent ESD-ITT
|
Colorectal ESD
|
Emergency surgery
|
Onco-surgery
|
CA recurrence
|
|
Initial ESD (≤30)
|
65
|
0 (mean 1.3)
|
4
|
0 (mean 0.9)
|
|
(31 centres)
|
[0 – 100]
|
[0 – 11]
|
[0 – 25]
|
[0 – 10]
|
|
Competent ESD (> 30
|
70
|
0.9 (mean 1.6)
|
5
|
0
|
|
(46 centres)
|
[0 – 92]
|
[0 – 10]
|
[0 – 18]
|
[0 – 0.1]
|
Conclusions:
ESD has been implemented at least in 46 centres across Europe on competent or professional level, with low risk during unsupervised learning. The majority (65 – 70%) are colorectal ESD, even during initial learning.
